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Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 956-959
A rare pathogen causing invasive infection in a child on chemotherapy

1 Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India

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Date of Submission01-May-2021
Date of Decision07-Nov-2021
Date of Acceptance18-Dec-2021
Date of Web Publication07-Jun-2022

How to cite this article:
Golla MK, Bhat RM, Lashkari HP. A rare pathogen causing invasive infection in a child on chemotherapy. Indian J Pathol Microbiol 2022;65:956-9

How to cite this URL:
Golla MK, Bhat RM, Lashkari HP. A rare pathogen causing invasive infection in a child on chemotherapy. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Nov 30];65:956-9. Available from:

Kocuria kristinae is a rare microbe causing infection in children. The genus Kocuria was previously classified in the Micrococcaceae family. It has been regrouped as Kocuria recently according to chemotaxonomic and phylogenetic studies.[1] Five out of 17 species of Kocuria were reportedly causing disease in humans, and K. kristinae is one of them.[2] It is an aerobe, which is catalase(+), coagulase(-), gram-positive coccus. It is a part of the human skin and oral flora and can cause bloodstream infections in immunocompromised and in patients with indwelling catheters.[3] The documented reports on Kocuria kristinae infection were very few and it is rarely reported in pediatric age group. We, here, summarize a case of Kocuria kristinae sepsis as a sign of possibility of disease from an uncommon organism and to steer up the proper antibiotic selection based on the Review of the literature '[Table 1].
Table 1: Pediatric case details of studies included in this review

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An 11-year-old male child who is a known case of Ewing's sarcoma in ethmoid sinus diagnosed at 10 years of age and had undergone 12 cycles of chemotherapy with Inj Vincristine, Inj Doxorubicin and Inj Cyclophosphamide, alternating with Inj Ifosfamide and Etoposide, according to EURO EWING 2012 protocol. Following completion of 12 cycles of chemotherapy, the child presented to casualty with the complaint of oral ulcers, throat pain, fever and pain, burning sensation during swallowing and decreased oral intake for two days. At admission, the child was pale, tired, febrile with a temperature of 102°F (38.9°C), and was tachycardic. The chemotherapy was being delivered via port-a-cath, which is an indwelling central venous catheter inserted soon after the diagnosis. Oral examination revealed curdy-white, non-scrapable deposits on the dorsum of the tongue with grade 4 mucositis. Blood samples were taken for investigations, and the child was started on empirical intravenous antibiotics – Cefoperazone-sulbactam and ciprofloxacin (for suspected febrile neutropenia), Intravenous fluids, and supportive oral care. Blood investigations showed anaemia (Hb – 8.5 gm/dl), leucopenia (Total White cell counts – 100 cells/cumm with absolute neutrophils 2 and lymphocytes 98 in number), elevated C-reactive protein (323.40 mg/l).

Blood culture was incubated in the BACTEC system, which showed growth after 11 hours. It was gram-positive cocci in clusters and tetrads irregularly. The sample was inoculated on chocolate, and blood agar showed tiny, pale, non-hemolytic, smooth, convex colonies. This organism was non-motile, catalase-positive, and coagulase-negative. Vitek2 compact automated identification system confirmed the growth as Kocuria kristinae. The modified Kirby-Bauer disc diffusion method was used to test drug sensitivity, and it was sensitive to Ampicillin, Ciprofloxacin, Ofloxacin, Clindamycin, Vancomycin, Teicoplanin, Piperacillin-Tazobactam and Ampicillin-Tazobactam.

Following the growth of Kocuria, Cefoperazone-sulbactam was discontinued, and intravenous Vancomycin 20 mg/kg/dose every 6 hours commenced and continued ciprofloxacin. He was afebrile by five days of treatment. Gradually mucositis resolved and started on the oral diet. The repeat blood investigations showed normal blood counts and repeat blood culture was negative done on the 5th day of antibiotics. The Inj Vancomycin was given for 7 days and he was discharged on oral Ciprofloxacin for 7 days with oral care.

An immunocompromised state due to chemotherapy leads to the risk of infections by organisms that are not considered primary pathogens. In these circumstances, Kocuria kristinae emerged as a new pathogen causing infections in immunocompromised patients and patients with a breach of oral or gut mucosal integrity. After discovering this organism, cases have been reported that this organism was found to be responsible for catheter-related infections in patients who were immunocompromised or on total parenteral nutrition. On literature review, so far, we found 11 case reports in which 11 pediatric patients and 8 neonatal patients were discussed. Most of the cases were catheter-related bloodstream infections. In contrast, the organism has also been detected in synovial fluid in two instances with septic arthritis,[4],[5] in a throat swab in one case,[6] and pus from umbilicus in one case.[7] One child with leukaemia was reported to have Kocuria kristinae infection.[8] In all the cases organism was sensitive to Penicillin, cephalosporins, quinolones and glycopeptides except one case which reported multidrug-resistant Kocuria growth[7] (Resistant to Penicillin, Oxacillin and Ciprofloxacin but susceptible to glycopeptides and linezolid). All the patients were treated with a combination of antibiotics with intravenous Vancomycin except for two cases, who were reated with IV Levofloxacin,[6] and the other was with Cefalothin.[5] So far, no mortality has been reported in pediatric cases due to Kocuria kristinae sepsis.

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   References Top

Stackebrandt E, Koch C, Gvozdiak O, Schumann P. Taxonomic dissection of the genus Micrococcus: Kocuria gen. nov., Nesterenkonia gen. nov., Kytococcus gen. nov., Dermacoccus gen. nov., and Micrococcus cohn 1872 gen. emend. Int J Syst Bacteriol 1995;45:682-92.  Back to cited text no. 1
Purty S, Saranathan R, Prashanth K, Narayanan K, Asir J, Sheela Devi C, et al. Erratum: The expanding spectrum of human infections caused by Kocuria species: A case report and literature review. Emerg Microbes Infect 2013;2:e91.  Back to cited text no. 2
Savini V, Catavitello C, Masciarelli G, Astolfi D, Balbinot A, Bianco A, et al. Drug sensitivity and clinical impact of members of the genus Kocuria. J Med Microbiol 2010;59:1395-402.  Back to cited text no. 3
Folić M, Janković S, Ružić-Zečević D, Pajević V, Rosić N, Nikolić P. Synovitis and periarticular bursitis of the coxofemoral joint caused by Kocuria Kristinae: A case report. Acta Fac Medicae Naissensis 2010;27:51-4.  Back to cited text no. 4
González-Arenas E, Castro-Soto-reyes LM, Sánchez-Camacho V, Pablo Yalaupari-Mejía J. Osteoartritis séptica por Kocuria kristinae. Reporte de un caso. Rev Mex Pediatr 2017;84:21-4.  Back to cited text no. 5
Lakshmikantha M, Devki V, Yogesh C. Case study is kocuria kristinae an upcoming pathogen ? Int J Curr Microbiol Appl Sci 2015;4:885-9.  Back to cited text no. 6
Sivaraman U, Subramanian P, Ramakrishnan K, Seetha KS. Umbilical sepsis caused by multidrug resistant strain of Kocuria Kristinae in a new born: A case report. J Clin Diagnostic Res 2016;10:DD01-2.  Back to cited text no. 7
Chen HM, Chi H, Chiu NC, Huang FY. Kocuria kristinae: A true pathogen in pediatric patients. J Microbiol Immunol Infect 2015;48:80-4.  Back to cited text no. 8
Lai CC, Wang JY, Lin SH, Tan CK, Wang CY, Liao CH, et al. Catheter-related bacteraemia and infective endocarditis caused by Kocuria species. Clin Microbiol Infect 2011;17:190-2.  Back to cited text no. 9
Oncel EK, Boyraz MS, Kara A. Black tongue associated with Kocuria (Micrococcus) kristinae bacteremia in a 4-month-old infant. Eur J Pediatr 2012;171:593.  Back to cited text no. 10
Mutlu M, An DG, Aslan Y, Sürer L, Aktaş F. Septic arthritis caused by kocuria kristinae in a Newborn. Hong Kong J Paediatr 2013;18:223-5. Available from: [Last accessed on 2021 Mar 03].  Back to cited text no. 11
Jermakow K, Mikołajków A, Pajączkowska M, Reczuch J, Fleischer M. Bloodstream infection due to Kocuria kristinae in preterm infant. Infections caused by Kocuria strains – human skin commensals. Forum Zakażeń 2016;6:379-85.  Back to cited text no. 12
Bhavsar SM, Hamula CL, Dingle TC. Report of two paediatric cases of central line infections caused by species of the genus Kocuria. JMM Case Rep 2016;3:1-3.  Back to cited text no. 13
Aydin M, Ganschow R, Jankofsky M. Kocuria kristinae-caused sepsis in an infant with congenital tufting enteropathy. Turk J Pediatr 2017;59:93-6.  Back to cited text no. 14

Correspondence Address:
Harsha P Lashkari
Department of Pediatrics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal - 576104, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_426_21

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